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General NPI Number Information
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NPI Number | 1003008277
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Entity Type | Organization
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Legal Business Name | BANNER HEALTH
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1650 COWLES ST DEPT 41B
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City | FAIRBANKS
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State | AK
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Zip | 99701-5925
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Country | US
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Telephone | 907-458-5621
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Fax | 907-458-5622
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Provider Business Mailing Address
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Address Line | 1650 COWLES ST DEPT 41B
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City | FAIRBANKS
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State | AK
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Zip | 99701-5925
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Country | US
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Telephone | 907-458-5621
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Fax | 907-458-5622
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MR. JOHN EDWARD COTTER
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Credential | RPH
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Telephone | 907-458-5621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 423
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License Number State | AK
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